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<html>
<head>
<meta name="viewport" content="width=device-width,initial-scale=1.0,maximum-scale=1.0,user-scalable=0"/>
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<title>4拼团-退款原因</title>
<link  href="__PUBLIC__/Wechat/api/css/style.css" rel="stylesheet"  type="text/css">
<script type="text/javascript" src="__PUBLIC__/Wechat/api/js/jquery-1.7.min.js"></script>
<script type="text/javascript" src="__PUBLIC__/Wechat/js/global.js"></script>
<script type="text/javascript" src="__PUBLIC__/Wechat/api/js/Vip/refundreason.js"></script>
<script type="text/javascript">$("document").ready(refundreason_obj.refundreason_apply);</script>
</head>

<body bgcolor="#f5f5f5">
<div class="header">
	<h1>退款申请</h1>
    <a href="javascript:history.back()" class="arrow-wrap"><em class="arrow-left"></em></a>
    <a href="?s=/Vip/index"><img src="__PUBLIC__/Wechat/api/images/me1.png"></a>
</div>
<div class="refundreason">
	<form id="form_refund">
		<div class="section1">
	    	<ul>
	        	<li><i>退款原因</i><span><input type="text" class="webtxt" placeholder="" name="reason" notnull></span></li>
	        	<li><i>联系人</i><span><input type="text" class="webtxt" placeholder="" name="linkman" notnull></span></li>
	            <li><i>联系电话</i><span><input type="text" class="webtxt" placeholder="" name="linktel" notnull></span></li>
	            <li><i>退款方式</i></li>
	            <li><p type="1">支付宝转账</p><div class="txt"><input type="text" class="webtxt" placeholder="请输入您的支付宝账号" name="pay"></div></li>
	            <li><p type="2">银行卡汇款</p><div class="txt"><input type="text" class="webtxt" placeholder="请输入您的银行卡号" name="bank"></div></li>
	        </ul>
	    </div>
		<div class="section2">
	    	<a href="#">申请退款</a>
	    </div>
		<div class="section3 bgfff">
	    	<div class="tips"><em><img src="__PUBLIC__/Wechat/api/images/bubblebg3.png"></em><i>温馨提示</i></div>
	        <div class="cont">“申请成功后请耐心等待审核，<br>1-5个工作日内客服会电话通知您审核结果~”</div>
	    </div>
	    <input type="hidden" name="orderid" value="{$orderid}">
    </form>
</div>
</body>
</html>
